What is ‘chronic’ pain?Pain is considered to be ‘chronic’ if it persists over a prolonged period of time (at least 3-6 months).

Can chronic pain be treated effectively? Yes. An individual and effective pain therapy, which may include the administration of strong pain killers from the onset, helps in immensely improving patients’ quality of life.

What are ‘strong’ pain killers?‘Strong’ pain killers support the body’s own pain inhibition in the central nervous system. This includes classical opioids, meaning active substances such as morphine or fentanyl, as well as substances of the class ‘MOR-NRI’ (Tapentadol).

These strong pain killers inhibit the proceeding of pain signals to the brain in the spinal cord. In doing this, they occupy the same binding sites as the body’s own opioids (= endorphins).

Why are strong pain killers referred to as narcotics?Opium (= morphine) is one of the oldest known drugs of the world. It was used in Egypt 3,000 years ago as medication against severe pain. Back then, the expression ‘narcotic’ was coined for this kind of substances, as they were used to narcotize the pain. In order to prevent the abuse of opiates as well as they natural and synthetic derivatives, a legal provision for handling these substances was passed in 1929; the German Narcotics Act (Betäubungsmittelgesetz, BtMG) and the Narcotics Prescription Regulation (Betäubungsmittelverschreibungsverordnung, BtMVV) deal with the specifics (such as special prescriptions and the documentation obligation).

The expression ‘narcotic’ is still used today for drugs covered by the afore-mentioned German Narcotics Act, even though often there is no ‘narcotic’ effect to these substances. This also holds true for modern pain killers.

But pain experts worldwide agree that the risk of psychological addiction is low if these drugs are handled correctly:

Modern pain killers have a lower risk of being addictive, not least because of their special mode of action and because of the special characteristics of tablets and plasters with sustained release of the active substance. If the drug is used as intended, meaning that the right dose is prescribed and it is correctly administered, a psychological addiction can almost be ruled out.

When are strong pain killers prescribed? Physicians no longer prescribe strong pain killers exclusively to patients with severe diseases. Today, strong pain killers are prescribed at an early stage of all forms of chronic pain in order to achieve adequate pain relief.

How are strong pain killers administered correctly?In order to achieve even pain relief for persistent pain, a constant level of the active substance in the blood must be achieved, which is why drugs for the treatment of chronic pain should be administered regularly according to a strict schedule and the instructions of the attending physician.

Do strong pain killers have side effects?In long-term pain treatment, modern pain killers rank among the more compliant drugs. However, some unpleasant side effects may occur, especially at the beginning of the therapy. Nausea and vomiting may potentially occur as adverse side effects. These medical conditions usually subside over time, but they are a burden, especially at the beginning of treatment. This is why the attending physician can prescribe a so-called antiemetic against these undesired symptoms. Fatigue and drowsiness may occur in the beginning as well, but these usually decrease after a couple of days. A side effect which is especially common amongst classical opioids (such as morphine) is digestion problems (constipation), but these can easily be treated with the help of medication and supporting measures such as sufficient fluids, high fibre food and – if possible – physical activity.

For all questions about possible side effects, the attending physician should be consulted.

Is it possible to drive a car when taking strong pain killers?The patient should refrain from driving at the beginning of the therapy, in the adjustment phase, when changing to a different pain killer or after a change of dose. During this time, side effects may occur which can reduce fitness and responsiveness.

As soon as the course of the therapy is stable, the overall condition is good and possible side effects and risks have been explained to the patient, then it is possible to operate vehicles from a medical point of view. It is advisable to consult the attending physician for an individual decision. If in doubt, the patient should consider a performance test (dexterity test at the MOT).

The patient should never stop taking strong pain killers without assistance. If unhappy with the therapy, he or she should consult the attending physician for further measures.

Travels to foreign countries need to be discussed with the physician at an early stage as he or she has to issue a certificate for carrying narcotics which has be approved by the highest state health authority or a commissioned department. Further details are provided on the website of the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM): http://www.bfarm.de/DE/Bundesopiumstelle/Betaeubungsmittel/Reisen/_node.htm

Patients are advised to refrain from drinking alcohol during the time of therapy, as this may reduce their responsiveness.

Further drugs should only be administered after consultation with the physician, as they may influence the effect of strong pain killers.

It is advisable to always carry an ID for opioids which needs to be issued by the attending physician so that, in case of emergency, medical staff will be aware that the patient is being treated with strong pain killers.

Stress intensifies medical conditions. Stress should thus be avoided in professional and personal life.

Consciously used methods of relaxation can help relieve the pain. Autogenic, acupuncture, hypnosis, and similar types of therapy may help to influence the sensation of pain positively. But also daily moments of leisure or – if possible – physical activity often help pushing the pain into the background.

Loneliness intensifies medical conditions. Maintaining contact to friends and loved ones can be a welcome change. If nothing else, affected persons may find encouragement and understanding in the exchange with others in self-help groups.

It can generally be said that a healthy lifestyle with a balanced diet and sufficient intake of liquids, enough sleep as well as the avoidance of alcohol contribute to better well-being.